创伤性脑脊液鼻漏的内镜手术治疗疗效分析

Endoscopic surgery and curative effect analysis of traumatic cerebrospinal fluid rhinorrhea

目的总结创伤性脑脊液鼻漏内镜手术治疗疗效。方法回顾性分析2015年11月-2019年8月东部战区总医院神经外科内镜与脑积水中心收治创伤性脑脊液鼻漏患者12例,其中男性5例,女性7例;年龄23~73岁,平均38.4岁。术前头颅CT及MRI定位瘘口位置,均行内镜下脑脊液鼻漏修补术。结果术中发现瘘口位置与影像学检查结构一致,12例初始有效率100%。1例患者拔除腰大池外引流管后出现颅内感染,并再次出现高流量脑脊液鼻漏,予患者行经颅显微外科治疗后治愈。1例经过多次内镜手术手术修补后仍有脑脊液鼻漏,经腰大池腹腔分流术后治愈。12例随访至今,无复发。结论经鼻内镜治疗创伤性脑脊液鼻漏具有创伤小、定位准确、视野显露佳、成功率高等优点。随着颅底重建技术的不断完善及提高,内镜修补创伤性脑脊液鼻漏将成为首选治疗方式,术后早期腰大池外引流及早期感染控制,是提高疗效的关键。由于颅内压力增高,伴有颅内压增高的多次修补无效患者,可行分流术。

Objective To summarize the curative effect of traumatic cerebrospinal fluid rhinorrhea treated by endoscopic surgery.Methods Twelve patients with traumatic cerebrospinal fluid rhinorrhea admitted to the Endoscopy and Hydrocephalus Center of the Department of Neurosurgery of Jinling Hospital from Nov. 2015 to Aug. 2019 were collected.There were 5 males and 7 females with an average age of 38.4(23-73) years. The preoperative CT and MRI position of the fistula were performed under neuroendoscopic cerebrospinal fluid rhinorrhea repair.Results The location of the fistula was consistent with the imaging examination during the operation.The initial effective rate of the 12 patients was 100%.One patient developed an intracranial infection after removal of the drainage tube outside the lumbar pool,and a high-flow cerebrospinal fluid rhinorrhea occurred again,which was cured after transcranial microsurgery.One patient had cerebrospinal fluid rhinorrhea after multiple endoscopic surgery and was cured by ventriculo-peritoneal shunt.Twelve patients were followed up without recurrence.Conclusion Endoscopic treatment of traumatic cerebrospinal fluid rhinorrhea has the advantages of small trauma,accurate positioning,good visual field and high success rate.With the continuous improvement and improvement of skull base reconstruction technology,endoscopic repair of traumatic cerebrospinal fluid rhinorrhea will become the first choice.Early postoperative drainage and early infection control is the key to improve the efficacy. For patients with multiple repair without effective results,ventriculo-peritoneal shunt is feasible.